Gregorakis Alkibiades K, Stefanakis Stefanos, Malovrouvas Dimitrios, Petraki Konstantina, Gourgiotis Dimitrios, Scorilas Andreas
Department of Urology, Attikon General Hospital, University of Athens, Athens, Greece.
Prostate. 2008 May 15;68(7):759-65. doi: 10.1002/pros.20733.
Radical cystoprostatectomy and radical prostatectomy are the two major operations where prostate is totally and radically removed. Radical cystoprostatectomy is usually performed in patients with invasive bladder cancer. The aim of the study was to examine Total PSA, Free PSA, and Free/Total Ratio elimination kinetics after radical cystoprostatectomy.
Serum PSA, Free PSA, and Free/Total Ratio were determined preoperatively, at the time of cystoprostatectomy specimen removal and then at 3, 6, 12, 24, 48, 72, and 168 hr, from seven patients with muscle invasive bladder cancer, who underwent radical cystoprostatectomy. Free and Total PSA concentrations were measured with non-competitive immunological procedures. The elimination rates and half-lives of Total, Free PSA and Free/Total Ratio were studied using a nonlinear regression analysis.
Surgical manipulations caused about 1.5-fold increase of PSA, 5-fold increase in Free PSA and 3-fold increase in Free/Total Ratio. PSA and Free PSA followed a biphasic elimination pattern of a rapid exponential (a) phase with a half-life of 4.27 and 2.14 hr and a terminal, nonexponential (b) phase with a half-life of 63 and 173.2 hr, respectively. Free/Total PSA Ratio followed, also, a biphasic kinetic pattern of a rapid exponential decline with a half-life of 3.34 and a terminal non-exponential increase with a doubling time of 43 hr.
Comparing PSA kinetics after radical cystoprostatectomy with those of radical prostatectomy, it appears that PSA follows the same elimination pattern in both models. In contrast, Free PSA and Free/Total Ratio elimination kinetics' patterns differ between the two surgical models.
根治性膀胱前列腺切除术和根治性前列腺切除术是两种将前列腺完全彻底切除的主要手术。根治性膀胱前列腺切除术通常用于浸润性膀胱癌患者。本研究的目的是检测根治性膀胱前列腺切除术后总前列腺特异抗原（Total PSA）、游离前列腺特异抗原（Free PSA）及游离/总比值的消除动力学。
对7例接受根治性膀胱前列腺切除术的肌层浸润性膀胱癌患者，在术前、切除膀胱前列腺标本时以及术后3、6、12、24、48、72和168小时测定血清PSA、Free PSA及游离/总比值。采用非竞争性免疫程序测量游离和总PSA浓度。使用非线性回归分析研究Total PSA、Free PSA及游离/总比值的消除率和半衰期。
手术操作导致PSA升高约1.5倍，Free PSA升高5倍，游离/总比值升高3倍。PSA和Free PSA呈现双相消除模式，快速指数（a）相的半衰期分别为4.27小时和2.14小时，终末非指数（b）相的半衰期分别为63小时和173.2小时。游离/总PSA比值也呈现双相动力学模式，快速指数下降的半衰期为3.34小时，终末非指数升高的倍增时间为43小时。
比较根治性膀胱前列腺切除术后与根治性前列腺切除术后的PSA动力学，似乎在两种手术模式中PSA遵循相同的消除模式。相比之下，两种手术模式中Free PSA和游离/总比值的消除动力学模式不同。
